Commonly body parts encountered Low back Neck Knee Elbow Shoulder
Common symptoms in orthopaedic Pain: muscle spasm,strain,overuse injury,degeneration,referred pain,past injury,malignancy Joint stiffness Neurological: numbness,weakness Others:e.g.deformity,locking,instability,givi ng way
Low back pain(LBP) Acute? Chronic? Localized? Diffuse? Other regions associated? Reliving factors? Occupation? Daily activity? Age?
LBP Common causes or Dx Degeneration Sprain or incorrect posture Overuse injury PID,spinal stenosis Other systems:e.g. renal colic,leaking AAA
LBP In P/E Point or level of tenderness Deformity Bone or muscle? Range of movement Neurological deficit Straight leg raising test
Management of LBP For simple LBP: Rest,correct posture,Ex or physiotherapy,Analgesics(topical or oral) Imaging if specific problem suspected e.g.XR,MRI Conservative or operative management
Neck pain Approach and management similar to LBP Note symptoms and signs of radiculopathy or myelopathy
Knee Post-injury? Chronic? Aggravating factors? Instability? Locking? Giving way? Swelling? Signs of inflammation? How daily life is affected?
Knee Common causes or Dx OA knee Soft tissue injury e.g. ligament,meniscus Loose body Gouty attack(more common in MTP joint of big toe)
Knee In P/E Deformity: Bow knee,Knock knee,Fixed flexion contracture Swelling,Effusion ROM Crepitus Instability
Management of Knee problem Imaging: XR,MRI To delay speed of degeneration e.g. weight reduction,avoiding frequent squatting or prolonged walking slopes or stairs To strengthen muscle for protecting the joint e.g. quadricep ex,swimming Analgesics Specific measures e.g. Arthroscopy,Surgery
Tennis Elbow Pain and tenderness at origin of the extensor muscles of the forearm,often radiating down to the back of forearm Caused by strain of the forearm extensor muscle at the point of their origin from the bone P/E : tenderness localized to the front of the lateral epicondyle of the humerus,pain elicited by passively stretching the extensor muscle Mx: Pain relive and NSAID,avoid overuse,tennis elbow band,ex,steroid injection
Shoulder Pain (from local tissue,or referred pain e.g. cervical spine,heart,diaphragm) Stiffness
Shoulder Frozen shoulder(adhesive capsulitis) Severe pain + limitation of shoulder movement in all direction No radiographic abnormality Natural course:spontaneous recovery within 6 to 12 months; with pain subsides first, then stiffness improved with active mobilization Mx: in acute painful stage,rest the shoulder with gentle assisted shoulder ex, NSAID,when pain lessens,active ex for regaining full ROM
Shoulder Pain arc syndrome Pain in shoulder during mid-range(45-160 degree) of shoulder abduction DDX: with Hx of injuryincomplete tear of supraspinatus,crack fracture of greater tuberosity of humerus; with spontaneous onset supraspinatus tendinitis,calcified deposit in supraspinatus,subacromial bursitis
Shoulder Painful arc syndrome Dx: by Hx,XR Mx: for crack # --analgesic,active mobilization for tendinits,bursitis,supraspinatus tear analgesic,physiotherpy e.g. short-wave diathermy,mobilization ex In resistant case,may need surgery